Aaron S. Farberg

Analysis of Trends in US Melanoma Incidence and Mortality

Analysis of Trends in US Melanoma Incidence and Mortality The incidence of and mortality from invasive melanoma in the United States has risen steadily for at least the past 2 decades.1 Similar trends are being seen worldwide despite numerous efforts to enhance primary prevention and early detection, and these increasing rates are having an impact on the public health and economic burden of disease. In 2009, we reported on the status of US melanoma incidence at that time.2 The purpose of this study was to provide updated information on trends in melanoma incidence and mortality that will help to elucidate the current state of this cancer in the United States.

Sun Protection by Beach Umbrella vs Sunscreen With a High Sun Protection Factor: A Randomized Clinical Trial

Importance Sun-protective behavior affects skin cancer prevention. Shade works by physically shielding skin from direct harmful UV rays; however, skin may still remain exposed to reflected and indirect UV rays. There is no current standard metric to evaluate shade for its effectiveness in sun protection, and there is insufficient clinical evidence that a beach umbrella alone can provide adequate sun protection. Objective To directly measure sunburn protection offered by a standard beach umbrella compared with that provided by sunscreen with a high sun protection factor under actual use conditions. Design, Setting, and Participants A single-center, evaluator-blinded, randomized clinical study was conducted from August 13 to 15, 2014, in Lake Lewisville, Texas (elevation, 159 m above sea level), among 81 participants with Fitzpatrick skin types I (n = 1), II (n = 42), and III (n = 38). Participants were randomly assigned to 2 groups: 1 using only a beach umbrella, and the other using only sunscreen with a sun protection factor of 100. All participants remained at a sunny beach for 3½ hours at midday. Clinical sunburn evaluation of each individual for all exposed body sites was conducted 22 to 24 hours after sun exposure. Interventions The shade provided by a beach umbrella or protection provided by sunscreen with a sun protection factor of 100. Main Outcomes and Measures Sunburn on all exposed body sites 22 to 24 hours after sun exposure. Results Among the 81 participants (25 male and 56 female; mean [SD] age, 41 [16] years) for all body sites evaluated (face, back of neck, upper chest, arms, and legs), the umbrella group showed a statistically significant increase in clinical sunburn scores compared with baseline and had higher postexposure global scores than the sunscreen group (0.75 vs 0.05; P < .001). There was a total of 142 sunburn incidences in the umbrella group vs 17 in the sunscreen group. Thirty-two of the 41 participants (78%) in the umbrella group showed erythema in 1 or more sites vs 10 of the 40 participants (25%) in the sunscreen group (P < .001). Neither umbrella nor sunscreen alone completely prevented sunburn. Conclusions and Relevance A beach umbrella alone may not provide sufficient protection for extended UV exposure. It is important to educate the public that combining multiple sun protection measures may be needed to achieve optimal protection. Trial Registration isrctn.org Identifier: ISRCTN19177299

Identification of high-risk cutaneous melanoma tumors is improved when combining the online American Joint Committee on Cancer Individualized Melanoma Patient Outcome Prediction Tool with a 31-gene expression profile–based classification

Background: A significant proportion of patients with American Joint Committee on Cancer (AJCC)‐defined early‐stage cutaneous melanoma have disease recurrence and die. A 31‐gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described. Objective: We sought to compare accuracy of the GEP in combination with risk determined using the web‐based AJCC Individualized Melanoma Patient Outcome Prediction Tool. Methods: GEP results from 205 stage I/II cutaneous melanomas with sufficient clinical data for prognostication using the AJCC tool were classified as low (class 1) or high (class 2) risk. Two 5‐year overall survival cutoffs (AJCC 79% and 68%), reflecting survival for patients with stage IIA or IIB disease, respectively, were assigned for binary AJCC risk. Results: Cox univariate analysis revealed significant risk classification of distant metastasis‐free and overall survival (hazard ratio range 3.2‐9.4, P < .001) for both tools. In all, 43 (21%) cases had discordant GEP and AJCC classification (using 79% cutoff). Eleven of 13 (85%) deaths in that group were predicted as high risk by GEP but low risk by AJCC. Limitations: Specimens reflect tertiary care center referrals; more effective therapies have been approved for clinical use after accrual. Conclusions: The GEP provides valuable prognostic information and improves identification of high‐risk melanomas when used together with the AJCC online prediction tool.

Dermatologists’ Perceptions, Recommendations, and Use of Sunscreen

Author Contributions: Ms Shah had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Shah, Mlacker, Aldahan, Carcioppolo, Bray, Nouri. Acquisition, analysis, or interpretation of data: Shah, Jacobsen, Aldahan, Carcioppolo, Nouri. Drafting of the manuscript: Shah, Jacobsen, Mlacker, Aldahan, Nouri. Critical revision of the manuscript for important intellectual content: Shah, Aldahan, Carcioppolo, Bray, Nouri. Statistical analysis: Shah, Jacobsen, Carcioppolo. Administrative, technical, or material support: Shah, Mlacker, Aldahan, Bray, Nouri. Study supervision: Carcioppolo.

Noninvasive Technologies for the Diagnosis of Cutaneous Melanoma

Multispectral analysis devices assess pigmented lesion disorganization at different levels using variable wavelengths of light. Computerized algorithms measure morphologic disorganization of the pigmented skin lesion. Aggregated data of 855 participants investigating the influence of multispectral digital skin lesion analysis (MSDSLA) on practitioner decisions to biopsy pigmented skin lesions revealed the overall sensitivity for detection of melanoma improved from 70% to 88%. Participant specificity increased from 52% to 58% after MSDSLA. Five studies using spectrophotometric intracutaneous analysis scope to evaluate suspicious pigmented skin lesions demonstrated an overall sensitivity and specificity of 85% and 81%, respectively, for the detection of melanoma.

SPF 100+ sunscreen is more protective against sunburn than SPF 50+ in actual use: Results of a randomized, double-blind, split-face, natural sunlight exposure clinical trial

Background: The value of additional photoprotection provided by use of high–sun protection factor (SPF) sunscreens is controversial, and limited clinical evidence exists. Objective: To compare the sunburn protection provided by SPF 100+ and SPF 50+ sunscreen in conditions of actual use. Methods: A total of 199 healthy men and women (≥18 years) participated in a natural sunlight, single‐exposure, split‐face, randomized, double‐blind study in Vail, Colorado. Each participant wore both sunscreens simultaneously during activities, with no use restrictions other than designation of the treatment area. Erythema was clinically assessed on the day following exposure. Comparative efficacy was evaluated through bilateral comparison of sunburn between treatment areas and erythema score, as evaluated separately for each treatment area. Results: Following an average 6.1 ± 1.3 hours of sun exposure, investigator‐blinded evaluation identified 55.3% of the participants (110 of 199) as more sunburned on the SPF 50+ protected side and 5% (10 of 199) on the SPF 100+ protected side. After exposure, 40.7% of the participants (81 of 199) exhibited increased erythema scores (by ≥1) on the SPF 50+ protected side as compared with 13.6% (27 of 199) on the SPF 100+ protected side. Limitations: Single‐day exposure may not extrapolate to benefits of longer‐term protection. Conclusion: SPF 100+ sunscreen was significantly more effective in protecting against sunburn than SPF 50+ sunscreen in actual use conditions.

Integrating Skin Cancer–Related Technologies into Clinical Practice

Early diagnosis and treatment of melanoma improve survival. New technologies are emerging that may augment the diagnosis, assessment, and management of melanoma but penetrance into everyday practice is low. In the current health care climate, greater emphasis will be placed on the incorporation of technology for clinically suspicious pigmented lesions to facilitate better, more cost-effective management.